The professional knowledge, skills and specialist functions of certified clinical coding auditors

The quality of Australia's coded clinical data is essential for its reliability in myriad applications throughout the healthcare system, signalling the need for clinical coding auditing. Internal clinical coding auditors audit hospitals' coded data, 'in-house'. Independent, external auditors undertake audits on behalf of purchasers and providers: state/territory governments; health insurance funds; private hospital proprietors.

To identify the professional knowledge, skills and specialist functions of certified clinical coding auditors in Australia.

A cross-sectional study design was utilised. A purposively designed, self-administered online survey was distributed to the study population (N = 241), who achieved a 'Certificate of External and Internal Clinical Coding Auditing' or 'Certificate of Internal Clinical Coding Auditing' from La Trobe University, Australia, from 2005 to 2021.

Of the 93/241 (38.6%) respondents, these results concern those who had engaged, predominantly, in either external or internal auditing within their previous 5 years of employment. The responses of 42 practising auditors were analysed: 83.3% (n = 35) had predominantly undertaken internal auditing within the past 5 years; 59.5% (n = 25/42) had a Certificate of External and Internal Clinical Coding Auditing, 28% (n = 7/25) of whom had predominately undertaken external auditing. The respondent-auditors reported on 52 core knowledges/skills/functions, which we aggregated into 4 discrete clusters: (a) health classification; (b) health informatics and technology; (c) health data analysis; (d) health information and business management. Of these knowledges/skills/functions, six applied to 100% of internal and external auditors; most applied fairly equally to external and internal auditors; four were utilised by <25% of external auditors; eight were used by <25% of internal auditors; 57.1% of external, and 68.6% of internal, auditors reported statistically analysing audit results.

The findings provide the first evidence-base for clinical coding auditors' knowledges/skills/functions, and prompt recommendations for their more extensive engagement in: (a) data analysis (including underpinning research methodology); and (b) preparation for artificial intelligence-related developments.Implications for health information management practice:This pioneering research on the work of clinical coding auditors provides a platform to inform (a) educational curricula updates, (b) development of professional competency standards for clinical coding auditors, (c) enhanced governance in audit practice and (d) development of national standards for clinical coding auditing.